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EP3261574B1 - Commande robotique de centre de déplacement distant avec logiciel et tube de guidage - Google Patents

Commande robotique de centre de déplacement distant avec logiciel et tube de guidage Download PDF

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Publication number
EP3261574B1
EP3261574B1 EP16756012.7A EP16756012A EP3261574B1 EP 3261574 B1 EP3261574 B1 EP 3261574B1 EP 16756012 A EP16756012 A EP 16756012A EP 3261574 B1 EP3261574 B1 EP 3261574B1
Authority
EP
European Patent Office
Prior art keywords
surgical
guide tube
portal
robotic
instrument
Prior art date
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Active
Application number
EP16756012.7A
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German (de)
English (en)
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EP3261574A4 (fr
EP3261574A1 (fr
Inventor
William Peine
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Covidien LP
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Covidien LP
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Publication of EP3261574A4 publication Critical patent/EP3261574A4/fr
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A61B34/35—Surgical robots for telesurgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B46/00—Surgical drapes
    • A61B46/10—Surgical drapes specially adapted for instruments, e.g. microscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3403—Needle locating or guiding means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3462—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00477—Coupling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A61B2034/301—Surgical robots for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A61B2034/302—Surgical robots specifically adapted for manipulations within body cavities, e.g. within abdominal or thoracic cavities
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A61B2034/305—Details of wrist mechanisms at distal ends of robotic arms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms

Definitions

  • Robotic surgical systems have been used in minimally invasive medical procedures in which surgical instruments were inserted through surgical portals at fixed entry points into the patient's body. These systems incorporated a Remote Center of Motion (RCM) to ensure that the surgical instruments did not move beyond these fixed entry points as the instruments were manipulated inside the patient's body.
  • RCM Remote Center of Motion
  • Many of these surgical robots used a mechanical RCM with a portion of robotic arm attaching directly to the surgical portal.
  • software-based RCM's typically did not mechanically connect to the surgical portal in order to provide an increased range of motion and reduce collisions between robotic arms of the surgical robot.
  • Unfortunately, many of the surgical robots with software-based RCM's tend to complicate instrument exchanges as the surgical portals moved out of alignment with the robotic arms when the surgical instruments were removed.
  • US2014066717A1 discloses a surgical port feature including a funnel portion, a tongue, a waist portion, and surgical instrument channels.
  • the waist portion may be located between the funnel portion and the tongue.
  • the surgical instrument channels may extend from the funnel portion through the waist portion.
  • the surgical port feature may further include a second tongue, with the wait portion being located between the funnel portion, the tongue, and the second tongue.
  • the present disclosure relates to a robotic surgical system as recited in the Claims.
  • distal refers to that portion of a device that is farther from the user
  • proximal refers to that portion of a device that is closer to the user.
  • a surgical system such as, for example, a robotic surgical system is shown generally as robotic surgical system 1 and generally includes a plurality of robotic arms 2, 3; a controller or control device 4; and an operating console 5 coupled with control device 4.
  • Operating console 5 includes a display device 6, which is set up in particular to display three-dimensional images; and manual input devices 7, 8, by means of which a person (not shown), for example a surgeon, is able to telemanipulate robotic arms 2, 3 in a first operating mode, as known in principle to a person skilled in the art.
  • Robotic surgical system 1 also includes a surgical assembly 100 connected to a distal end of each of robotic arms 2, 3.
  • Surgical assembly 100 may support one or more surgical instruments such as surgical instruments 200, 300, as will be described in greater detail below.
  • robotic arm 2 (and/or robotic arm 3) includes a mounting portion 2a having an outer surface 2b and an inner surface 2c.
  • Inner surface 2c defines a receiving passage 2d therethrough and outer surface 2b that may support a sterile drape 2e thereon.
  • Sterile drape 2e can be disposable and/or replaceable.
  • Inner surface 2c may form a shoulder 2g that functions to support one of surgical instruments 200, 300.
  • Robotic arms 2, 3 may be driven by electric drives (not shown) that are connected to control device 4.
  • Control device 4 e.g., a computer
  • Control device 4 is set up to activate the drives, in particular by means of a computer program, in such a way that robotic arms 2, 3, their surgical assemblies 100 and/or surgical instruments 200, 300 execute a desired movement according to a movement defined by means of manual input devices 7, 8.
  • Control device 4 may also be set up in such a way that it regulates movement of robotic arms 2, 3 and/or of the drives.
  • robotic arms 2, 3 While electrically coupled to controller or control device 4, as described above, robotic arms 2, 3 are configured to receive signals from controller 4, which may be software-based, to establish a remote center of motion at any suitable location as described in greater detail below.
  • Robotic surgical system 1 is configured for use on a patient "P" lying on a patient table 12 to be treated in a minimally invasive manner by means of an end effector of one or more of the surgical instruments.
  • Surgical system 1 may also include more than two robotic arms 2, 3, the additional robotic arms likewise being connected to control device 4 and being telemanipulatable by means of operating console 5.
  • One or more additional surgical assemblies 100 and/or surgical instruments 200, 300 may also be attached to the additional robotic arm.
  • Control device 4 may control a plurality of motors (Motor 1... n) with each motor configured to drive a pushing or a pulling of one or more cables of surgical instruments 200, 300.
  • the plurality of motors can include a plurality of motors 202a of an instrument drive unit 202 of surgical instruments 200, 300 as shown in FIG. 2 .
  • the one or more cables effect operation and/or movement of end effectors 210, 310 of surgical instruments 200, 300. It is contemplated that control device 4 coordinates the activation of the various motors (Motor 1...
  • each motor can be configured to actuate a drive rod or a lever arm to effect operation and/or movement of end effectors 210, 310 in addition to, or instead of one or more cables.
  • Control device 4 can include any suitable logic control circuit adapted to perform calculations and/or operate according to a set of instructions. Control device 4 can be configured to communicate with a remote system "RS," either via a wireless (e.g., Wi-Fi, Bluetooth, LTE, etc.) and/or wired connection. Remote system “RS” can include data, instructions and/or information related to the various components, algorithms, and/or operations of work station 1. Remote system “RS” can include any suitable electronic service, database, platform, cloud “C,” or the like. Control device 4 may include a central processing unit operably connected to memory. The memory may include transitory type memory (e.g., RAM) and/or non-transitory type memory (e.g., flash media, disk media, etc.). In some embodiments, the memory is part of, and/or operably coupled to, remote system "RS.”
  • a wireless e.g., Wi-Fi, Bluetooth, LTE, etc.
  • Remote system “RS” can include data, instructions and/or information related to the various components, algorithms
  • Control device 4 can include a plurality of inputs and outputs for interfacing with the components of robotic surgical system 1, such as through a driver circuit. Control device 4 can be configured to receive input signals and/or generate output signals to control one or more of the various components (e.g., one or more motors) of robotic surgical system 1. The output signals can include, and/or can be based upon, algorithmic instructions which may be preprogrammed and/or input by a user. Control device 4 can be configured to accept a plurality of user inputs from a user interface (e.g., switches, buttons, touch screen, etc. of operating console 5) which may be coupled to remote system "RS.”
  • a user interface e.g., switches, buttons, touch screen, etc. of operating console 5
  • a database 14 can be directly and/or indirectly coupled to control device 4.
  • Database 14 can be configured to store pre-operative data from living being(s) and/or anatomical atlas(es).
  • Database 14 can include memory which can be part of, and/or or operatively coupled to, remote system "RS.”
  • surgical assembly 100 includes a guide tube 110, a first surgical instrument 200, a second surgical instrument 300, and one or more surgical portals 400.
  • First and second surgical instruments 200, 300 can be the same and/or different types of instruments (e.g., a grasper, stapler, cutter, sealer, or the like).
  • surgical assembly 100 includes a second surgical portal 500 and a further second surgical instrument 600 such as an endoscope, for example.
  • Guide tube 110 extends between a proximal or trailing end 110a of guide tube 100 and a distal or leading end 110b of guide tube 110.
  • a housing 112 is disposed at trailing end 110a of guide tube 110, and an elongated tubular body 114 extends distally from housing 112 to distal end 110b of guide tube 110.
  • Guide tube 110 can be formed from any suitable material such as stainless steel for example to enable sterilization and reuse of guide tube 110. Additionally, and or alternatively guide tube 110 or portions thereof can be formed of transparent material. For example, leading end 110b can be transparent to provide visualization for determining a location/position of surgical instruments advanced therethrough.
  • Guide tube 110 can also be grounded (e.g., via a grounding rod or the like not shown) during electrosurgery, for example, to provide electrical isolation. Guide tube 110 may be electrically configured to detect faulty insulation of an electrosurgery instrument.
  • Housing 112 includes an outer surface 112a and an inner surface 112b. Housing 112 includes a top surface 112c and a bottom surface 112d. Top surface 112c can form an annular flange 112e that extends radially outwardly from housing 112, and bottom surface 112d can form an annular shoulder 112f that couples elongated tubular body 114 to housing 112.
  • Elongated tubular body 114 includes an outer surface 114a and an inner surface 114b.
  • Inner surface 114b of elongated tubular body 114 and inner surface 112b of housing 112 define a passage 116 that opens through leading and trailing ends 110a, 110b of guide tube 110.
  • An internal seal 118 such as a disc seal and/or duckbill valve, for example, is supported in housing 112 and extends from inner surface 112b of housing 112. Internal seal 118 is positioned within housing 112 to receive first and/or second surgical instruments 200, 300 therethrough in a sealed relationship with a respective one of the first and/or second surgical instruments 200, 300.
  • Each of surgical instruments 200, 300 includes an instrument drive unit 202 supported at a proximal end thereof and a shaft assembly 204 that extends distally from instrument drive unit 202.
  • Shaft assembly 204 includes one or more cables such as cables 206, 208 that extend therealong and/or therethrough to an end effector 210 and/or an end effector 310 coupled to a distal end of shaft assembly 204.
  • end effectors 210, 310 can include any suitable end effector known in the art such as a grasper, stapler, sealer or the like that functions to manipulate, fasten, cut, and/or seal tissue.
  • Proximal ends of cables 206, 208 are coupled to instrument drive unit 202 and actuatable in response to activation of one or more motors 202a supported within instrument drive unit 202 to operate end effectors 210, 310.
  • surgical portal 200 includes a body 410 having an outer surface 410a and an inner surface 410b.
  • Inner surface 410b defines a passage 412 that opens at trailing and leading ends 410c, 410d of body 410.
  • Body 410 includes an annular flange 414 that extends radially outwardly from body 410 at trailing end 410c of body 410.
  • An internal seal 416 such as a disc seal and/or a duck-bill valve, for example, is supported in passage 412 that functions to establish a sealed relationship with instruments such as first and second instruments 200, 300 and/or endoscope 600 advanced therethrough into a surgical site "S" while body 410 is positioned within a tract of tissue "T.”
  • surgical portals 400, 500 are positioned within tissue "T.”
  • endoscope 600 As shown in FIG. 2 , with endoscope 600 advanced through surgical portal 500 into surgical site "S" adjacent to surgical portal 400, endoscope 600 functions to establish a field of view "F" within surgical site "S” to view surgical site "S," first instrument 200, second instrument 300, guide tube 110, and/or surgical portal 400.
  • mounting portion 2a of robotic arm 2 is positioned adjacent to, and in alignment with, surgical portal 400 to establish/set a remote center of motion (RCM), for example, a set software-based RCM, based upon the location of surgical portal 400.
  • the location of surgical portal 400 can be stored (e.g., electronically via controller) as desired.
  • the RCM and/or location of robotic arm 2 can be based on a longitudinal axis "L" that extends through leading and trailing ends 410c, 410d of surgical portal 400.
  • Mounting portion 2a of robotic arm 2 may be positioned relative to surgical portal 400 such that a longitudinal axis "L2" that extends through receiving passage 2d of robotic arm 2 is coaxial with longitudinal axis "L" of surgical portal 400.
  • Positioning of robotic arm 2 may be based on electrical communications from control device 4 corresponding to the location of surgical portal 400 and/or longitudinal axis "L" thereof.
  • Elongated tubular body 114 of guide tube 110 is then advanced through receiving passage 2d of robotic arm 2 such that mounting portion 2a and sterile drape 2e support housing 112 on robotic arm 2 and leading end 110b of guide tube 110 extends into passage 412 of surgical portal 400 with internal seal 416 of surgical portal 400 sealingly engaged with outer surface 114a of guide tube 110.
  • Housing 112 of guide tube 110 can be received in receiving passage 2d of robotic arm 2 such that annular flange 112e of housing 112 engages sterile drape 2e to provide a sterile connection between guide tube 110 and robotic arm 2.
  • guide tube 110 With guide tube 110 supported by robotic arm 2, guide tube 110 is positionable relative to surgical portal 400 such that leading end 110b of guide tube 110 can extend distally beyond leading end 410d of surgical portal 400 and into surgical site "S.”
  • Robotic arm 2 is movable axially relative to longitudinal axes "L” and “L2,” as indicated by arrow "A1," ( FIG. 3 ) to adjust axial positioning of guide tube 110 relative surgical portal 400 while maintaining alignment between robotic arm 2 and surgical portal 400 via guide tube 110.
  • axial movement of guide tube 110 may be effectuated at any time during a procedure to provide access to different areas within surgical site "S" based upon a location of leading end 110b of guide tube 110.
  • guide tube 110 receives, for example, first surgical instrument 200 and establishes a sealed relationship with shaft 204 of first surgical instrument 200 via internal seal 118 as first surgical instrument 200 is received by guide tube 110.
  • First surgical instrument 200 is advanced through guide tube 110 so that end effector 210 of first surgical instrument 200 extends distally beyond leading ends 110b, 410d of guide tube 110 and surgical portal 400, respectively, and into field of view "F" of endoscope 600 within surgical site "S.” End effector 210 can then be utilized to operate within surgical site "S" as desired.
  • first surgical instrument 200 can be withdrawn and replaced with second surgical instrument 300.
  • alignment between robotic arm 2 and surgical portal 400 can be maintained with guide tube 110 (via the software-based RCM) during the entirety of the instrument exchange and including when no surgical instrument is positioned within surgical portal 400.
  • Leading end 110b of guide tube 110 remains within the field of view "F" of endoscope 600 during the procedure and during instrument exchange to enable clinician to determine a final, exact in vivo location of end effector 310 of second surgical instrument 300.
  • One or more subsequent instrument exchanges can be effectuated as desired, similar to that described above, with first surgical instrument 200, second surgical instrument 300, and/or other suitable surgical instruments in order effectuate various steps/procedures with the various instruments.
  • guide tube 110 provides a barricaded conduit to protect surrounding patient tissue from undesired tissue damage resulting from snagging or the like.
  • guide tube 110 can be utilized without surgical portal 400 such that guide tube 110 advances directly through the tissue "T.”
  • guide tube 110 includes one or more markings, light emitting diodes, and/or light pipes for various identification purposes. For example, light communicated from a diode or light pipe may communicate information such as whether or not a robotic arm is active, an instrument exchange is being undergone, an instrument is armed, etc.
  • Guide tube 110 may also include one or more sensors for measuring force such as force exerted by tissue (e.g., abdominal wall) which can be subtracted from measured forces applied to a proximal end of one of the instruments.
  • guide tube 110 can also be utilized in conjunction with surgical portal 500 to facilitate use of one or more endoscopes 600 in a manner similar to that described with respect to surgical portal 400 and instruments 200, 300.
  • guide tube 110 may define a separate lumen that receives a fluid (e.g. saline) for cleaning a lens of endoscope 600.
  • a fluid e.g. saline

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • Public Health (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Robotics (AREA)
  • Pathology (AREA)
  • Manipulator (AREA)
  • Surgical Instruments (AREA)
  • Endoscopes (AREA)

Claims (4)

  1. Système chirurgical robotique (1), comprenant :
    un portail chirurgical (400) ;
    un robot chirurgical comportant un bras de robot (2, 3) et un organe de commande (4), l'organe de commande étant configuré pour établir un centre de mouvement distant, RCM, basé sur logiciel d'un instrument chirurgical (200, 300) fixé au bras de robot en fonction d'une localisation du portail chirurgical (400) chez un patient à travers lequel l'instrument chirurgical est inséré ; et
    un tube de guidage (110) ayant une extrémité arrière (110a) supportée par le bras de robot du robot chirurgical, une extrémité avant (110b) insérée dans le portail chirurgical et
    dans lequel un alignement est maintenu entre le bras robotique et le portail chirurgical pendant un échange d'instrument chirurgical y compris le moment où l'instrument chirurgical n'est pas dans le portail chirurgical par l'intermédiaire du RCM basé sur logiciel,
    le tube de guidage comportant un corps tubulaire allongé (114) à travers lequel la tige allongée de l'instrument chirurgical est insérée ou retirée pendant l'échange d'instrument chirurgical,
    dans lequel le tube de guidage peut être déplacé de manière coulissante par rapport au portail chirurgical en réponse à un mouvement du bras robotique, et
    dans lequel le tube de guidage et le bras robotique définissent un premier axe longitudinal qui s'étend entre les extrémités avant et arrière du tube de guidage, et dans lequel le portail chirurgical définit un second axe longitudinal qui s'étend entre les extrémités avant et arrière de celui-ci, le tube de guidage étant conçu pour maintenir un alignement coaxial du premier axe longitudinal et du second axe longitudinal pendant l'échange d'instrument chirurgical par l'intermédiaire du RCM basé sur logiciel
    dans lequel le bras de robot et l'instrument chirurgical peuvent être déplacés robotiquement dans le sens axial par rapport aux premier et second axes longitudinaux par coulissement du tube de guidage par rapport au portail chirurgical.
  2. Système chirurgical robotique selon la revendication 1, dans lequel le tube de guidage comporte un joint interne (118) conçu pour maintenir une relation étanche avec des instruments chirurgicaux reçus au sein du tube de guidage.
  3. Système chirurgical robotique selon l'une quelconque revendication précédente, dans lequel le tube de guidage est formé d'un matériau électroconducteur, et dans lequel le tube de guidage est relié à la terre.
  4. Système chirurgical robotique selon l'une quelconque revendication précédente, comportant en outre un champ stérile (2e) positionné entre le tube de guidage et le bras robotique.
EP16756012.7A 2015-02-26 2016-01-21 Commande robotique de centre de déplacement distant avec logiciel et tube de guidage Active EP3261574B1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US201562121283P 2015-02-26 2015-02-26
PCT/US2016/014219 WO2016137612A1 (fr) 2015-02-26 2016-01-21 Commande robotique de centre de déplacement distant avec logiciel et tube de guidage

Publications (3)

Publication Number Publication Date
EP3261574A1 EP3261574A1 (fr) 2018-01-03
EP3261574A4 EP3261574A4 (fr) 2018-10-31
EP3261574B1 true EP3261574B1 (fr) 2024-12-18

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EP16756012.7A Active EP3261574B1 (fr) 2015-02-26 2016-01-21 Commande robotique de centre de déplacement distant avec logiciel et tube de guidage

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US (3) US10517684B2 (fr)
EP (1) EP3261574B1 (fr)
JP (1) JP6657244B2 (fr)
CN (2) CN107257670B (fr)
WO (1) WO2016137612A1 (fr)

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US20180042686A1 (en) 2018-02-15
CN112998861B (zh) 2024-06-07
EP3261574A4 (fr) 2018-10-31
EP3261574A1 (fr) 2018-01-03
US20210212781A1 (en) 2021-07-15
CN107257670B (zh) 2021-03-16
JP6657244B2 (ja) 2020-03-04
WO2016137612A1 (fr) 2016-09-01
JP2018506358A (ja) 2018-03-08
US10517684B2 (en) 2019-12-31
CN112998861A (zh) 2021-06-22
CN107257670A (zh) 2017-10-17
US10959794B2 (en) 2021-03-30
US20200121405A1 (en) 2020-04-23

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